【作者】 王颖玲；

【导师】 王子军；

【作者基本信息】 中国疾病预防控制中心 ， 公共卫生， 2008， 硕士

【摘要】 背景突发公共卫生事件应对能力是指一个机构所拥有的能承担应对突发公共卫生事件任务的各要素的总和,是政府、尤其是卫生行政管理部门的一种重要执政能力,是卫生机构与专业人员业务素质与水平的直接表现。石景山区为北京市八个城区之一,是奥运场馆聚集区,公共卫生保障工作任务艰巨;辖区内近年来每年均有突发公共卫生事件发生。石景山区疾病预防控制中心是辖区内突发公共卫生事件预防和处置的核心部门,医院和学校在突发公共卫生事件应对过程中是主要的信息来源地以及突发事件早期发现、识别、处置地。石景山区疾控、医疗和教育部门突发公共卫生事件的应对能力是决定突发公共卫生事件的发生、发展及其造成危害的关键。目的对突发公共卫生事件应对能力进行调查,了解相关部门突发公共卫生事件应对能力状况,发现薄弱环节,能够有针对性地提高突发公共卫生事件应对能力,为加强本区公共卫生应急体系建设并提高应急处置能力提供依据并提出相应的政策建议。研究设计与方法采取普查和分层抽样的方法选取石景山区疾病预防控制中心、医疗机构和教育机构作为机构调查对象,分别对石景山区疾控、医疗和教育机构进行突发公共卫生事件应对能力机构和个人调查。采用现况调查的方法,通过统一设计的调查表和调查问卷形式分别对石景山区疾病预防控制中心、辖区25家医疗机构、20所中小学校和20所托幼机构进行应急能力机构调查,对专业技术人员进行应对能力个人调查。机构调查内容包括:机构基本情况,突发公共卫生事件准备情况,监测和预警情况,突发事件的识别和诊疗,信息报告和数据分析,教育和培训;个人调查内容包括:个人基本情况,突发公共卫生事件应对能力情况,相关知识掌握情况。所有数据统一录入Epidata 3.1数据库,用SAS 9.0软件进行统计学分析。结果1.石景山区突发公共卫生事件发生的特点石景山区每年均有突发公共卫生事件的发生,但发生频率较低。传染病突发公共卫生事件是石景山区最重要的突发公共卫生事件类型,学校和工地等人员密集地区是突发公共卫生事件的高发场所。2.石景山区疾控中心突发公共卫生事件应对能力石景山区疾病预防控制中心制定了规范的、应对常见突发公共卫生事件应急预案,储备了较为齐备的应急物资;建立了多种公共卫生监测系统,对监测信息能够及时上报,监测资料定期进行整理和分析并对结果进行反馈;疾控中心实验室具有一定的传染病致病原、化学毒物检测能力;每年举办各类教育培训和重点疫情的应急演练。需要增加应急物资的储备,扩大监测和预警的范围,加强数据分析和反馈工作。调查疾控中心专业技术人员59人,专业人员对于麻疹、甲肝、水痘突发事件的应对比较有信心;对常见传染病突发事件和食物中毒事件的应对能力相对较强,对各类事件上报、应急处理原则掌握和流行病学调查能力方面较强;专业人员对监测数据进行整理分析的能力不足;对消毒器械使用、消毒液的配制、防护用品的使用掌握比例较高;对传染病和突发事件相关知识的掌握情况较好。需要加强专业人员教育培训特别是专业技术培训和演练工作,提高专业人员数据的分析能力。3.石景山区医疗机构突发公共卫生事件应对能力石景山区各级医疗机构中,7家二级以上医疗机构突发公共卫生事件应对能力高于二级以下医疗机构。25家各级医疗机构均制定了突发公共卫生事件应急预案;84%机构进行传染病的预检分诊;二级以上医疗机构建立了多种传染病和症状监测系统进行突发事件的监测和早期预警;部分二级以上医疗机构制定了突发事件有关疾病治疗方案,在突发事件中的病人不能得到治疗时,大部分医疗机构会将其专职专科医院或高级别医疗机构进行诊疗。调查医疗机构传染病和突发事件识别、报告和处理相关专业人员130人,专业人员具备一定的突发公共卫生事件应对能力。专业技术人员对于水痘、流感、细菌性食物中毒、麻疹突发事件的应对比较有信心;对常见传染病突发事件和食物中毒事件的应对能力相对较强,对各类事件上报能力方面较强;专业人员对监测数据进行整理分析的能力较低;对消毒器械使用、消毒液的配制、防护用品的使用掌握比例较高;对传染病和突发事件相关知识的掌握情况较好。4.石景山区教育机构突发公共卫生事件应对能力石景山区各类教育机构中,公办教育机构突发公共卫生事件应对能力强于民办机构。公办教育机构中有92.59%制定了卫生保健制度,民办机构制定相关制度的仅有38.46%;公办和民办教育机构中分别有88.89%和53.85%的机构开展晨午检工作;大部分教育机构配备有食堂或有集中用餐情况,制定了食品卫生制度;各教育机构采取烧开水放置保温桶或桶装水的方式供应饮用水。调查教育机构卫生保健人员98人,卫生保健人员每年定期接受卫生保健知识培训;传染病的识别主要从相关症状表现识别,通过老师、医疗单位或家长告知;卫生保健人员对水痘、腮腺炎的识别能力较强;能够掌握传染病和突发事件的报告方式;对传染病和突发事件相关知识的掌握情况较好。结论1.石景山区面临着突发公共卫生事件的威胁,迫切需要加强突发公共卫生事件应对能力建设。2.石景山区疾病预防控制中心具备较强的突发公共卫生事件应对能力,但需加强资金和政策支持,提高政府对公共卫生的重视程度。疾控中心专业技术人员能够应对突发事件的威胁,但需强化风险和应急意识;加强现场处置能力培训和演练,着重加强培训和演练的效果;增强公共卫生监测和数据分析能力。3.石景山区医疗机构和教育机构具备一定的突发公共卫生事件应对能力。二级以上医疗机构应对能力强于二级以下医疗机构;公办教育机构应对能力强于民办机构。医疗机构和教育机构专业人员应提高传染病和突发事件的风险意识和早期识别能力,增强报告意识。4.突发公共卫生事件应急能力建设是长期的任务,需疾病预防控制中心、各级医疗机构和教育机构共同不懈努力。更多还原

【Abstract】 BackgroundResponse capability to Public health emergency refers to the sum of all elements an institute has to respond to public health emergency.It is an important administrative capability for the government,especially health administrative management department,and direct demonstration of professional quality and competency of both health agency and professionals.As one of eight urban districts of Beijing,Shijingshan District is an area where Olympic venues are densely distributed,thus leading to a very tough task for public health guarantee;in recent years,many public health emergencies have occurred in the district every year.Shijingshan District of Beijing Centre for Disease Prevention and Control(Shijingshan CDC) is the core department to prevent and dispose of public health emergency within the jurisdiction of Shijingshan District and hospitals and schools act as main information sources in response to public health emergency and the places for early identification,recognition and handling of such emergency. Response capabilities of Shijingshan CDC,medical and education departments to public health emergency play a critical role in determining occurrence,development and hazards of any public health emergency.ObjectivesTo carry out an investigation into the response capability to public health emergency,understand status quo of the response capability of relevant departments, find out weak points,analyze any and all insufficiencies,put forward appropriate countermeasures and suggestions,specifically improve the response capability to public health emergency,and provide basis and sound suggestions for the purpose of strengthening public health response system building and response handling capability of the district. Research design and methodologyGeneral investigation and layered sampling were adopted to carry out institutional and individual survey of response capability to public health emergency on Shijingshan CDC,and medical and education institutions,all of which are chosen as the institutional investigation objects.Institutional surveys on response capability was carried out in Shijingshan CDC,and 25 medical institutions,20 primary and middle schools and 20 babysitting institutions under the jurisdiction of Shijingshan District by using status quo survey with the uniformly designed survey form and survey questionnaire;individual surveys on response capability was carried out among 59,130 and 98 professionals from the said institutions,respectively. Institutional survey involves general information on the institution,preparedness for public health emergency,monitoring and early warning condition,information reporting and data analysis,and education and training while individual survey involves general information on individuals,response capability to public health emergency and relevant knowledge.All data will be input into Epidata 3.1 database and subject to statistical analysis with SAS 9.0 software.Results1.Characteristics of occurrence of public health emergency in Shijingshan DistrctPublic health emergency does occur in Shijingshan every year,but frequency is relatively low.Public health emergency concerning communicable diseases is the most important type of public health emergency in Shijingshan District and many densely populated areas such as schools and construction sites are at high risk against public health emergency.2.Response capability of Shijingshan CDC to public health emergencyShijingshan CDC has formulated normative contingent plans for common public health emergencies,stocked relatively complete emergency response materials, established a couple of public health monitoring systems to allow for timely reporting of monitoring information and regular clean-up of monitoring data as well as proper feedback;CDC Lab is provided with certain capacity to detect pathogens of communicable diseases and chemical toxic substances;CDC also holds various education trainings and carries out response exercise against critical epidemics on a yearly basis.Things to be done include increasing reserves of emergency relief materials,expanding the scope of monitoring and early warning,and strengthening data analysis and feedback.Professionals in Shijingshan CDC shows great confidence in response to such emergencies as measles,hepatitis A and chicken pox,strong capability in responding to outbreak of common communicable diseases and food poisoning incidents as well as reporting of various emergencies,understanding of contingent handling principles and epidemiological suryey;insufficiency is found in professionals’ capability of clean-up and analysis on monitoring data:they highly command of utilization of disinfection equipments,preparation of disinfection solutions and use of personal protective products;they have excellent knowledge of information relating to communicable diseases and public health emergency.Things to be done include strengthening education and training towards professionals,especially professional technology training and drilling,and improving data analysis capability of all professionals.3.Response capability of medical institutions in Shijingshan District to public health emergencyAmong medical institutions at various levels in Shijingshan District,those institutions above the second level show greater response capability to public health emergency than those under the second level.All medical institutions have formulated contingent plans against public health emergency;84%of them implement pre-testing diagnosis against communicable diseases;medical institutions above the second level have established multiple monitoring svstems of communicable diseases and symptoms to carry out monitoring and early warning against public health emergency: some medical institutions above the second level has formulated treatment plans against retevant diseases in case of any public health emergency,according to which most hospitals may transfer those patients who can not be treated in case of any outbreak to special hospital or higher medical institution for diagnosis and treatment.In these medical institutions,professionals from relevant disciplines demonstrate certain emergency response capability in identification,reporting and handling of communicable diseases and emergencies.Professional technicians show great confidence in responding to such emergency incidents as chicken pox,influenza, bacterial food poisoning and measles as well as reporting of various emergencies; professionals" capability is found low in terms of clean-up and analysis on monitoring data;they highly command of utilization of disinfection equipments,preparation of disinfection solutions and use of personal protective products;they have excellent knowledge of information relating to communicable diseases and public health emergency.4.Response capability of education institutions in Shijingshan District to public health emergencyAmong various education institutions,those public education institutions show greater capability to respond public health emergency than those private ones.92.59% of public education institutions have formulated healthcare rules while only 38.46% of the private counterparts have done the same;88.89%of public education institutions and 53.85%of private ones have carried out morning and afternoon inspections,respectively;most of education institutions have been provided with dining halls or adopted mass dinning and established food hygiene regulations;all education institutions supply drinking water by means of provision of temperature-constant bucket containing boiled water or provision of bottled water.Health care professionals in education institutions are trained for health care knowledge at regular intervals every year;identification of communicable diseases is mainly conducted through relevant symptoms or being informed by teachers,medical agencies or parents;Health care professionals show strong capability in identifying chicken pox and parotitis,are capable of commanding reporting means of communicable diseases and public health emergency,and also have excellent idea of information relating to communicable diseases and emergent incidents.Conclusions5.Since Shijingshan District is exposed to threats from public health emergency,it is imperative to strengthen building of response capability to public health emergency.6.Though having relatively strong capability of responding to public health emergency,Shijingshan CDC still needs support in fund and policy and is required to raise the emphasis of the government on public health.Professionals in Shijingshan CDC are able to respond to threats from emergent incidents while their awareness of risk and emergency response needs to be enhanced;Other things to be done include strengthening training and drilling regarding field handling capability,especially enhancement of training and drilling effects,and improving the capability of public health monitoring and data analysis. 7.Medical and education institutions in Shijingshan District show certain capability to respond to public health emergency.Medical institutions above the second level have stronger response capability than those under the second level;public education institutions show stronger response capability than those private counterparts.Professionals from both medical and education institutions are required to improve their risk awareness and early identification capability relating to communicable diseases and emergent incidents as well as their reporting awareness.8.Since public health emergency response capability building is a long-term task,it is necessary for CDC and medical and education institutions at various levels to make common ceaseless effort.更多还原